Pediatric Pulmonology | Specialists and Information

Pulmonology covers the entire respiratory system. In addition to the lungs, the respiratory tract also includes the paranasal sinuses, the larynx, and the trachea.

In pulmonary medicine, the focus is primarily on the bronchi, the mediastinum (the space between the lungs), and the pleura (the lining of the chest, lungs, and ribs).

Of course, diseases of the lungs themselves are also part of pulmonology. The causes and symptoms of lung diseases differ significantly in newborns, children, and adolescents compared to adults.

Due to the unique characteristics of children, pediatric pulmonology deals with diseases of the airways and respiratory system in children.

Pediatric pulmonology is a subspecialty of pediatrics. A pediatric pulmonologist is a physician who has completed a five-year residency to become a specialist in pediatrics and adolescent medicine. Afterward, they undergo a three-year fellowship in the field of pediatric pulmonology.

Training to become a pediatric pulmonologist focuses on acquiring knowledge regarding the diagnosis and treatment of respiratory diseases, particularly those affecting the lungs, bronchi, pleura, and mediastinum in children and adolescents.

The most common lung disease in childhood is bronchial asthma. It is a chronic respiratory disease characterized by episodic shortness of breath with difficulty exhaling.

A pediatric pulmonologist also treats recurrent bronchial inflammation and pneumonia, as well as chronic lung diseases that often occur following premature birth.

A pediatric pulmonologist is also the right specialist for the following conditions:

• Cystic fibrosis
• Congenital lung and airway malformations that can lead to recurrent lung infections, such as: unventilated sections of the lung (pulmonary sequestra), Lung hyperinflation (pulmonary emphysema), cysts in the lungs and bronchi, tracheal diverticula (dilatations in the trachea), and bronchial narrowing
• Sleep-related breathing disorders such as sleep apnea syndrome
• Tuberculosis
• Interstitial lung diseases (diffuse lung parenchymal disease), such as sarcoidosis or exogenous allergic alveolitis (allergic overreaction of the lungs)
• Lung diseases in premature infants and newborns, such as bronchopulmonary dysplasia (impaired lung function)
• Respiratory distress syndrome 
• Obstructions (narrowing) of the upper airways
• Pulmonary disorders of the pulmonary circulation, such as pulmonary hypertension (high blood pressure in the lungs)
• Pulmonary allergies
• Abnormal breathing sounds in infants
• Chronic cough

About 10% of all children and adolescents in Germany suffer from bronchial asthma @ megaflopp /AdobeStock

The pediatric pulmonologist first asks about:

• The child’s symptoms
• Lifestyle habits
• Medications taken, as well as
• Past illnesses or diseases in family members (medical history)

This is followed by a physical examination. An important part of the examination is auscultation. Here, the specialist uses a stethoscope to listen to the sounds produced in the lungs and surrounding tissues. This provides clues as to whether there is an airway obstruction, pulmonary hyperinflation, or inflammation.

The pediatric pulmonologist can test lung function using spirometry or body plethysmography. These tests are also referred to as pulmonary function tests (PFTs).

They provide information on:

• How much air the patient inhales and exhales
• How much air remains in the lungs after exhalation, and
• How fast the air flows

This allows the pediatric pulmonologist to accurately assess the functional status of the airways and lungs. As a result, they can detect diseases at an early stage.

During the lung function test, the child breathes into the measuring device (spirometer) exclusively through the mouth using a mouthpiece @ Aliaksandr Siamko /AdobeStock

In spirometry, the patient breathes into a device through a mouthpiece while holding their nose closed. The device records various lung function parameters.

Body plethysmography is essentially similar. However, during the examination, the patient is inside an airtight glass chamber. This method is slightly more accurate than spirometry.

Ergo-spirometry measures lung function during physical exertion. During the test, the patient is on a stationary bike or a treadmill. This allows the doctor to detect hidden lung disorders that only manifest during physical exertion.

Pulse oximetry, on the other hand, provides information about oxygen saturation in the blood. In some lung diseases, the oxygen content in the blood drops.

Another diagnostic procedure is bronchoscopy. In this procedure, the doctor inserts an endoscope into the patient’s airways through the mouth or nose while the patient is under anesthesia.

Using a camera, the doctor can then examine the bronchi and the lungs. During bronchoscopy, the doctor can also collect mucus as well as cell and tissue samples (bronchoalveolar lavage, bronchial lavage).

In addition, the pediatric pulmonologist has other diagnostic options available, such as:

• Ultrasound examinations (sonography) of the lungs and pleura, as well as other imaging tests such as chest X-rays and lung scintigraphy (perfusion scintigraphy, ventilation scintigraphy)
• Sputum analysis (examination of sputum)
• Pilocarpine iontophoresis sweat test (also known simply as the sweat test) to detect cystic fibrosis

Treatment depends primarily on the specific condition. If breathing difficulties are caused by an inhaled foreign object, the doctor can remove it directly during a bronchoscopy.

In cases of bacterial pneumonia, the doctor prescribes antibiotics. These are not effective against viral infections, however. To prevent a so-called bacterial superinfection, children are often given antibiotics nonetheless.

Some lung diseases cannot be treated at their root cause. The goal here is not a cure, but rather the relief of symptoms.

For example, patients with cystic fibrosis receive mucolytic medications and training on how to cough up mucus using autogenic drainage.

They also offer asthma education so that children and parents can learn how to manage the condition.

Long-term oxygen therapy, ventilator therapy, and home ventilation are treatment options for particularly severe lung diseases.